Healthcare Provider Details

I. General information

NPI: 1215950126
Provider Name (Legal Business Name): KATHY M DANZE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 SW REGATTA LN
BEAVERTON OR
97006-8942
US

IV. Provider business mailing address

PO BOX 42510
PORTLAND OR
97242-0510
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-2131
  • Fax: 503-617-9379
Mailing address:
  • Phone: 503-963-1290
  • Fax: 503-230-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1216
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: